Sclerosing encapsulating peritonitis (SEP) in patients on continuous ambulatory peritoneal dialysis

Definition, diagnosis and treatment recommendations, 1997 update

Abstract

Sclerosing encapsulating peritonitis (SEP) is one of the most serious complications of CAPD. To revise the definition, diagnosis and therapeutic strategy for sclerosing encapsulating peritonitis (SEP) in patients on CAPD proposed over the last 3 years, a consensus meeting on SEP was held on November 29, 1997 in Tokyo. We confirmed that SEP is defined as clinical entity demonstrating persistent, intermittent and/or recurrent clinical symptoms due to adhesive bowel obstruction in patients receiving peritoneal dialysis. This year, we made minor changes concerning the recommended treatment of SEP. The basic strategy for the treating SEP is sustained bowel rest. Long-term total parental nutrition (TPN) therapy is effective for treating SEP patients. It was reported that steroid pulse therapy was effective in 6 of 8 and corticosteroid administration was effective in 15 of 23 patients treated at 26 hospitals, although there were some reports of fatal outcomes. This therapeutic intervention as well as an immunosuppressive regimen should be evaluated in a large patient population.
We also proposed criteria for discontinuing CAPD to prevent the development of SEP in adult and pediatric patients. However, SEP showed heterogeneity among individual patients. Therefore, we proposed only a basic strategy for treating SEP in this revised version. Further study is needed in this area.